Introduction The SCENIC consensus statement recommends endoscopic resection of all visible dysplasia1. Due to technical challenges and limited experience in the West of large colitis associated non-polypoid endoscopic resections, such patients are often subjected to colectomy.
The King’s Institute of Therapeutic Endoscopy (KITE) is a tertiary centre for endoscopic assessment and resection of large/challenging colorectal polyps. Here we present the largest single centre case series of large non-polypoid resections associated with colitis.
Method Data including demographics, clinical history, lesion characteristics, method of resection and post-resection surveillance were collected prospectively in patients with visible lesions associated with colitis from January 2011 to November 2016. Resection techniques included endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD) and hybrid ESD. Surveillance of resection site with magnification chromendoscopy (mCE) was performed at 3 months and pan colonic mCE at 1 year post resection and annually thereafter.
Results Thirteen lesions satisfied the inclusion criteria in 13 patients. Mean lesion size was 47.3+/-22.4 (20–90) mm. All lesions were non polypoid with distinct margins and no ulceration (Fig.1). High frequency mini-probe ultrasound confirmed intramucosal lesions in 5 cases where pit/vascular pattern was distorted due to inflammation. En bloc resection was achieved in 6 cases. 69% lesions were deeply scarred of which 66% had experienced prior instrumentation. Resection of a single lesion was abandoned due to intense fibrosis. Macroscopic evidence of complete resection was achieved in all remaining cases. Endoscopic diagnosis of pre-cancerous lesions of less than 1000 µm submucosal invasion was confirmed histopathologically in 100% of resected lesions. A single case of small perforation and another with delayed minor bleeding were both managed endoscopically. Mortality/hospital admission within 30 days post resection was 0%. Median follow up was 28 months (12-35) with no recurrence. Alternative site dysplasia was detected in n=2. All lesions were sub 20 mm and resected endoscopically. Two patients were referred for colectomy due to a concomitant diagnosis of neuroendocrine tumour and the second with alternate site advanced dysplasia.
Conclusion This cohort series demonstrates that endoscopic resection of large non-polypoid lesions in association with colitis is feasible using an array of resection methods, safe and has good long term outcomes in a western tertiary endoscopic centre.
. Laine L, Kaltenbach T, Barkun A, et al. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastrointest Endosc. 2015;81(3):489–501
Disclosure of Interest None Declared
- Endoscopic Resection
- Inflammatory Bowel Disease